CMS Price Transparency Data

X-ray, lower back

Facility: Holy Family Memorial

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72110
  • Insurance Median: $351
  • Cash Discount Price: $285
  • vs. Medicare Baseline: 3.29x Medicare
The contracted insurance negotiated median rate for a X-ray, lower back at Holy Family Memorial is $351. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $285. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.29x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.
Cash / Self-Pay
$285

Average discount available for prompt cash payment at this facility.

Insurance Median
$351

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $285 (267%)
Insurance Median: $351 (329%)
Cash: $285 (267% of Medicare)
Ins. Median: $351 (329% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 329% of the Medicare baseline (a markup of 229%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group Contract Rate Range vs. Medicare Reference
Blue Cross Blue Shield $66 - $101 62%
Community Care Incorporated $101 95%
Health Partners $101 - $337 95%
Humana $101 95%
Icare $101 95%
Molina $101 - $109 95%
Network Health Plan $101 - $399 95%
Security Health Plan $101 - $415 95%
UnitedHealthcare $101 - $597 95%
Allwell $103 96%
Medical College Of Wisconsin $171 160%
Centivo $208 - $239 195%
Health Payment Systems $244 228%
Dean Health Plan $260 243%
Sheboygan Employers Health Network $311 291%
Chorus Community Health Plan $334 313%
Trilogy $343 321%
Cigna $374 350%
Wps Health Plan $384 360%
Aspirus $415 389%
Healtheos $415 389%
Multiplan/Private Healthcare Systems $415 389%
Preferred One $415 389%
Healthsmart $431 404%
First Health Network $457 428%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 2300 Western Ave, Manitowoc, WI 54221
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Other
  • Hospital Type: Acute Care Hospitals